Active NPI
Jennifer Maytum, CPNP
- Nurse Practitioner
- Saint Paul, MN
National Provider Identifier
1629150248
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- R1036837
- Practice address
- 200 University Ave E
Saint Paul, MN 55101-2507 - Phone
- (651) 325-2121
- Fax
- (651) 325-2122
- NPI assigned
- Oct 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | R1036837 | MN | Primary |
Addresses
Primary practice location
200 University Ave E
Saint Paul, MN 55101-2507
Mailing address
200 University Ave E
Saint Paul, MN 55101-2507
Phone (651) 325-2121
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 858326900 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Pediatric Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1150 | MN | MD | Genetic Counselor (M.S.) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161302400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1199404800000",
"number": "1629150248",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 UNIVERSITY AVE E",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551012507",
"telephone_number": "651-325-2121",
"fax_number": "651-325-2122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 UNIVERSITY AVE E",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551012507",
"telephone_number": "651-325-2121",
"fax_number": "651-325-2122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAYTUM",
"first_name": "JENNIFER",
"credential": "CPNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-20",
"last_updated": "2008-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MN",
"license": "R1036837",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "858326900",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.